Clamp having bendable shaft

ABSTRACT

A clamp has a handle assembly, a gripping assembly having a pair of jaws that can be opened and closed to grip an element, and a shaft assembly. The shaft assembly has a flexible shaft having a proximal end that is operatively coupled to the handle assembly and a distal end that is operatively coupled to the gripping assembly. The shaft assembly also has a rigid element that can be placed in a first position where the rigid element supports the shaft in a manner where the shaft cannot be bent, and in a second position where the shaft can be bent.

RELATED CASES

This is a continuation-in-part of application Ser. No. 09/847,135, filedMay 2, 2001, whose disclosure is incorporated by this reference asthough set forth fully herein.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to medical devices, and in particular, toa clamping device that has a bendable shaft.

2. Description of the Prior Art

Clamping devices are typically used to occlude blood vessels during asurgical procedure. Conventional clamping devices are also known asclamps, and have a shaft that connects a pair of jaws with a handle atopposite ends thereof. The pair of jaws open and close about a pivotpoint in a motion that resembles that of a scissors. These conventionalclamps are typically made from stainless steel and the shaft istherefore completely rigid. As a result, such conventional clamps arebulky and can interfere with the surgeon's access to the surgical site.To address this problem, elastic bands were sometimes used to hold thehandles of the clamp away from the location of the surgical site.

With the increasing popularity of minimally invasive surgicalprocedures, access to the surgical site is reduced, thereby creating aneed for smaller clamping devices, or clamping devices that can be movedaway from the surgical site after the blood vessel has been clamped bythe clamping device. As a result, the conventional clamps posesignificant access problems to the surgeon when used during minimallyinvasive surgical procedures.

Thus, there remains a need for an improved clamping device that can beused to effectively clamp a blood vessel at a surgical site, while notinterfering with the surgeon's access to the surgical site.

SUMMARY OF THE DISCLOSURE

It is an object of the present invention to provide a clamp that doesnot interfere with a surgeon's access to the surgical site during use.

It is another object of the present invention to provide a clamp thatcan effectively clamp a blood vessel at a surgical site.

It is yet another object of the present invention to provide a clampwhose handle can be moved away from the surgical site after the clamphas clamped the blood vessel.

It is yet another object of the present invention to provide a clampthat has a shaft which can be both completely rigid and completelyflexible, with the rigid shaft being capable of withstanding axialloads, side loads, and moments applied to the jaws of the clamp.

It is yet another object of the present invention to provide a clampthat can be used in open and endoscopic surgeries.

It is yet another object of the present invention to provide a clampthat prevents rotation of the jaws when in use.

The objectives of the present invention are accomplished by providing aclamp having a handle assembly, a gripping assembly having a pair ofjaws that can be opened and closed to grip an element, and a shaftassembly. The shaft assembly has a flexible shaft having a proximal endthat is operatively coupled to the handle assembly and a distal end thatis operatively coupled to the gripping assembly. The shaft assembly alsohas a rigid element that can be placed in a first position where therigid element supports the shaft in a manner where the shaft cannot bebent, and in a second position where the shaft can be bent.

The clamp can be utilized in a surgical procedure by first introducingthe jaws through a surgical site or a trocar, and then closing the jawsto grip a blood vessel, tissue or other anatomical structure. The rigidelement can be withdrawn or otherwise removed so that the flexible shaftcan be conveniently bent by the surgeon to a position or location sothat the handle assembly does not interfere with access to the surgicalsite.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a clamp according to the presentinvention with the shaft completely covered by telescoping tubes.

FIG. 2 is a perspective view of the clamp of FIG. 1 with the shaft notcovered by telescoping tubes.

FIG. 3A is a cross-sectional view of a portion of the shaft of the clampof FIG. 1.

FIG. 3B is a perspective view of a portion of the shaft of FIG. 3A.

FIG. 4 is a perspective sectional view of the shaft assembly of theclamp of FIG. 1.

FIG. 5 is an exploded perspective view of the shaft assembly of theclamp of FIG. 1.

FIG. 6A is a cross-sectional view of the handle assembly of the clamp ofFIG. 1 with the telescoping tubes deployed over the shaft.

FIG. 6B is a cross-sectional view of the handle assembly of the clamp ofFIG. 1 with the telescoping tubes retained inside the handle assembly.

FIG. 7 is a cross-sectional view of the stop member of the clamp of FIG.1.

FIG. 8 is an isolated perspective view of the proximal tube bushing ofthe clamp of FIG. 1.

FIG. 9A is a cross-sectional view of the gripping assembly of the clampof FIG. 1 with the jaws open and the lock mechanism locked with thehelix cylinder.

FIG. 9B is a cross-sectional view of the gripping assembly of the clampof FIG. 1 with the jaws closed and the lock mechanism locked with thehelix cylinder.

FIG. 9C is a cross-sectional view of the gripping assembly of the clampof FIG. 1 with the jaws open and the lock mechanism disengaged from thehelix cylinder.

FIG. 10 is an exploded perspective view of the gripping assembly of theclamp of FIG. 1.

FIGS. 11A, 11B and 11C are top perspective, bottom perspective, andcross-sectional views, respectively, of the helix cylinder of the clampof FIG. 1.

FIGS. 12A and 12B are perspective and cross-sectional views,respectively, of the cable holder in the gripping assembly of the clampof FIG. 1.

FIGS. 13A and 13B are perspective and cross-sectional views,respectively, of the lock mechanism of the clamp of FIG. 1.

FIG. 13C is an enlarged sectional view of the region labeled R in FIG.13B.

FIGS. 14A and 14B are perspective and cross-sectional views,respectively, of the dowel pin used with the lock mechanism of the clampof FIG. 1.

FIG. 15 is an exploded perspective view of the handle assembly of theclamp of FIG. 1.

FIG. 16 is a perspective view of the cable holder of the handle assemblyof the clamp of FIG. 1.

FIG. 17 is a perspective view of the adjuster piece of the handleassembly of the clamp of FIG. 1.

FIG. 18 is a perspective view of the end housing of the handle assemblyof the clamp of FIG. 1.

FIG. 19 is a perspective view of one handle piece of the handle assemblyof the clamp of FIG. 1.

FIG. 20 is a perspective view of another handle piece of the handleassembly of the clamp of FIG. 1.

FIG. 21 is a perspective view of a ratchet release button of the handleassembly of the clamp of FIG. 1.

FIG. 22 is a perspective view of another ratchet release button of thehandle assembly of the clamp of FIG. 1.

FIG. 23 is a perspective view of a handle end piece of the handleassembly of the clamp of FIG. 1.

FIG. 24 is side perspective view of portions of the handle assembly ofthe clamp of FIG. 1 showing the ratchet disengaged from the ratchetrack.

FIG. 25 is a side perspective view of portions of the handle assembly ofthe clamp of FIG. 1 showing the ratchet engaged to the ratchet rack.

FIG. 26 is a bottom perspective view of portions of the handle assemblyof the clamp of FIG. 1 showing the ratchet engaged to the ratchet rack.

FIG. 27 is an enlarged sectional perspective view of the proximal partof the shaft of the clamp of FIG. 1.

FIG. 28 is a cross-sectional view illustrating the nesting of adjacenttelescoping tubes of the clamp of FIG. 1.

FIG. 29 is a perspective view of the gripping assembly of the clamp ofFIG. 1 shown in use with different jaws.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The following detailed description is of the best presently contemplatedmodes of carrying out the invention. This description is not to be takenin a limiting sense, but is made merely for the purpose of illustratinggeneral principles of embodiments of the invention. The scope of theinvention is best defined by the appended claims. In certain instances,detailed descriptions of well-known devices and mechanisms are omittedso as to not obscure the description of the present invention withunnecessary detail.

The present invention provides a clamping device that has a flexible andbendable shaft that can be supported by a rigid element. When theclamping device is being held and controlled by the surgeon prior toclamping a blood vessel, tissue or other anatomical structure, the rigidelement can be deployed to support the flexible shaft so that the entireclamping device is generally rigid. After the clamping device has beenused to clamp a blood vessel, tissue or other anatomical structure, therigid element can be withdrawn or otherwise removed so that the flexibleshaft can be conveniently bent by the surgeon to a position or locationso that the handle assembly does not interfere with access to thesurgical site.

FIGS. 1 and 2 are perspective views illustrating the clamp 20 of thepresent invention. The clamp 20 has a shaft assembly having a flexibleshaft 22 having a proximal end 24 that is operatively connected to ahandle assembly 26, and a distal end 28 that is operatively connected toa gripping assembly 30. A plurality of telescoping tubes 32 can bewithdrawn and stored in nested fashion inside the handle assembly 26(see FIG. 2), or can be fully deployed to completely cover the shaft 22(see FIG. 1).

Shaft Assembly and Telescoping Tubes

Referring now to FIGS. 2-5, the shaft 22 can be flexible to the pointwhere it would be completely flexible (in other words, limp, flaccid,pliable, compliant and not stiff) when the shaft 22 is not supported byany other element, yet despite being completely flexible, is stillcapable of withstanding axial loads. In one embodiment that is bestillustrated in FIGS. 3A and 3B, the shaft 22 can be made up of aplurality of two types of beads 36 a and 36 b that are alternated withrespect to each other. Both types of beads 36 a and 36 b have athree-dimensional convex torus configuration, which is best shown inFIG. 3B. The first beads 36 a have a smaller inner diameter than thesecond beads 36 b. The first beads 36 a have an outer diameter that issmaller than, equal to, or greater than, the outer diameter of thesecond beads 36 b. Each second bead 36 b rides (i.e., is supported) onthe outer surface 37 a of two adjacent first beads 36 a, so that eachsecond bead 36 b is essentially in a raised position with respect to thefirst beads 36 a. In particular, the convex circumferential portion 37 bof each second bead 36 b contacts or rides on the outer surface 37 a oftwo adjacent first beads 36 a. FIG. 3B illustrates four alternatingbeads 36 a, 36 b in a region X where all the beads 36 a, 36 b are shownconnected to each other, and another three beads 36 a, 36 b in a regionY where the beads 36 a, 36 b are shown to be separated from each othersolely for illustrative purposes. The beads 36 a, 36 b are preferablymade of a material that is hard and stiff, with good wear properties.Non-limiting examples of such a material for the beads 36 include metal,plastics, composites and/or ceramics. Each bead 36 a and 36 b can have,in one embodiment, an inner diameter of about 0.03 to 0.20 and 0.05 to0.22 inches, respectively, and an outer diameter of about 0.09 to 0.30and 0.09 to 0.30 inches, respectively. Preferably, between a total of 10to 100 beads 36 a and 36 b can be connected together to form the shaft22.

As shown in FIG. 3A, each bead 36 a, 36 b can be provided with athrough-hole or bore 38 so as to form a longitudinal bore through theshaft 22, with an internal wire cable 40 retained inside the bores 38.The beads 36 are lined up side-by-side in abutting fashion to form theshaft 22. The construction of a shaft 22 having alternating first andsecond beads 36 a, 36 b has exhibited improved flexibility even when thejaws 260, 262 of the gripping assembly 30 are clamped together. Thecontact between the adjacent beads 36 a, 36 b can be characterized as aline contact (as contrasted with conventional ball-and-socket jointswhich have surface contacts), in which one bead 36 a contacts anadjacent bead 36 a, 36 b along a ring of points (e.g., LC in FIG. 3A).The construction of the beads 36 a, 36 b enables the line contactbetween adjacent beads 36 a, 36 b to exist at all times, even when theshaft 22 is bent. This line contact between the adjacent beads 36 a, 36b also minimizes the friction between adjacent beads 36 a, 36 b when theshaft 22 is bent. As a result, the shaft 22 illustrated in FIGS. 3A and3B will be more flexible when the jaws 260, 262 of the gripping assembly30 are closed, so that when the surgeon moves the handle assembly 26away from the surgical site, less torque or force is transmitted to theblood vessel by the gripping assembly 30, and trauma to the blood vesselcan be minimized.

The cable 40 is always in tension, and is utilized to control theopening and closing of the jaws 260, 262 of the gripping assembly 30, aswill be described in greater detail below. The cable 40 can be embodiedin the form of any conventional cable that is used in clamping devices,and can be made, for example, from stainless steel or tungsten, amongother examples.

The proximal end 24 of the shaft 22 abuts a distal end 44 of a proximaltube 42 that is secured inside the handle assembly 26, as shown in FIGS.4 and 6A. The proximal tube 42 can be provided in one piece, or in aplurality of pieces (e.g., two separate pieces 42 a, 42 b as shown inFIGS. 4 and 5) for easier manufacturing, and can include holes 43 thatallow for flushing of the cable 40 during cleaning. When provided in twoor more pieces, each separate piece (e.g., 42 a and 42 b in FIG. 4) canhave chamfered ends (not shown) that are adapted to mate or couple withthe adjacent piece. In addition, one or more of the separate pieces 42a, 42 b can have a flat region 41 that facilitates convenient gripping(e.g., by a wrench) during assembly of the clamp 20.

The cable 40 extends through the interior of the proximal tube 42. Astop member 46 is threadably connected to the proximal end 48 of thetube 42. The stop member 46 acts as a stop member for the telescopingtubes 32, and in particular, the proximal-most telescoping tube 32 a.Referring also to FIG. 7, the stop member 46 has a distal flange 45, agenerally cylindrical shaft 47 and a proximal flange 49. A threaded bore31 extends from an opening in the distal flange 45 to a central portionof the shaft 47, and a clearance hole 33 extends from an opening in theproximal flange 49 to the location where the threaded bore 31terminates. The proximal-most end of the proximal tube 42 has externalthreads (not shown) which can be threadably engaged with the internalthreads (not shown) inside the threaded bore 31 to couple the proximaltube 42 to the stop member 46. The proximal flange 49 acts as a stopmember by abutting the proximal shoulder 137 of a bore 110 of the handlepiece 116 (see FIG. 6A).

Referring to FIG. 5, a lock nut 50 can be threaded at the proximal-mostend of the proximal tube 42 to secure the threaded connection betweenthe proximal tube 42 and the stop member 46. The length of the threadedconnection between the tube 42 and the stop member 46 can be adjusted bythe manufacturer of the clamp 20 during the assembly of the handleassembly, simply by rotating one of the stop member 46 or the proximaltube 42 with respect to the other about the threaded connection.Adjusting the length of the threaded connection between the tube 42 andthe stop member 46 allows the length of the shaft 22 to be adjusted,which in turn allows for (i) tensioning of the cable 40, and (ii)adjustment the maximum opening angle of the jaws 260, 262 of thegripping assembly 30. In this regard, the manufacturer can increase ordecrease the length of the threaded connection between the tube 42 andthe stop member 46 by turning stop member 46 or tube 42 with respect toeach other, and then tightening the lock nut 50 to prevent the threadedconnection from coming loose. When the length of the threaded connection(between the stop member 46 and the tube 42) is decreased, the stopmember 46 and the tube 42 are moved away from each other, therebyincreasing the length of the shaft 22. By increasing the length of theshaft 22, the length of the cable 40 that protrudes from each end of theshaft 22 is decreased. This effectively decreases the length of thecable 40 relative to the shaft 22, which increases the maximum tensionin the cable 40 and decreases the maximum opening angle of the jaws ofthe gripping assembly 30. Similarly, by increasing the length of thethreaded connection, the stop member 46 and the tube 42 are movedtowards each other, thereby decreasing the length of the shaft 22. Thiseffectively increases the length of the cable 40 relative to the shaft22, which decreases the maximum tension in the cable 40 and increasesthe maximum opening angle of the jaws of the gripping assembly 30.

A plurality of telescoping tubes 32 can be used to provide rigidity tothe beaded shaft 22. Each telescoping tube 32 has an inner bore 52. Anynumber of telescoping tubes 32 can be provided, and according to oneembodiment of the present invention, one to five telescoping tubes 32are provided. Each telescoping tube 32 can have any desiredcross-section (e.g., circular, square, rectangular or elliptical, amongothers), and is preferably made from a substantially rigid material,such as plastic, aluminium, titanium and stainless steel, among others.The proximal-most telescoping tube 32 a has the largest diameter andlargest inner bore 52, while the diameters and sizes of the inner bores52 of the intermediate telescoping tubes 32 become progressively smalleruntil the distal-most telescoping tube 32 b, which has the smallestdiameter and smallest inner bore 52. This configuration allows theplurality of telescoping tubes 32 to be nested within each other andstored inside the handle assembly 26.

The telescoping tubes 32 can be locked or secured in their fullydeployed configuration that is shown in FIG. 1. To accomplish this, theouter surface of each tube 32 can be provided with one or more dimples139 that are positioned to engage corresponding locking tabs 141 thatare provided at the distal end of each of the tubes 32. See FIG. 28. Thedistal-most tube 32 b does not need to have a tab 141. Each tab 141 canbe slid back and forth along the outer surface of the smaller adjacenttube 32 as the two adjacent tubes 32 reciprocate with respect to eachother, and can be clicked into the corresponding dimple 139 during thissliding motion. The tab 141 can be compliant enough so that asufficiently large axial force will disengage the tab 141 from thecorresponding dimple 139 for further sliding motion.

Each telescoping tube 32 also has an internal bushing 56 (see FIGS. 6Band 28) that is provided on the outer surface at the proximal end ofeach telescoping tube 32. Each bushing 56 is cylindrical in nature andis retained for sliding movement between the outer surface of thesmaller tube 32 and the inner surface of the adjacent larger tube 32.The proximal end of each telescoping tube 32 is provided with a pair ofbosses 35 that capture (axially) the bushing 56 that couples an adjacenttelescoping tube 32 when the telescoping tubes 32 are withdrawn.Referring to FIGS. 6A, 6B and 8, a proximal stop member 68 is attached(e.g., by glue, screws, brazing or welding) to the proximal-mosttelescoping tube 32 a to act as a stop member for the adjacent (andsmaller-diameter) telescoping tube 32. The proximal stop member 68 has agenerally circular proximal surface 67 that abuts against the distalflange 45 of the stop member 46 when all the telescoping tubes 32 arewithdrawn and retained inside the handle assembly 26. A narrow-diameterflange 69 extends from the distal side of the proximal stop member 68and is adapted to be pressed into the inner diameter at the proximal endof the proximal-most telescoping tube 32 a. The outer diameter of theproximal stop member 68 is sized to allow the proximal stop member 68 toslide inside a bore 110 of the handle piece 116 (see FIGS. 6A and 6B)that is described in greater detail hereinbelow.

The bushings 56 function to promote smooth sliding of the telescopingtubes 32 within each other, and to promote stiffness to the region ofthe shaft 22 when the shaft 22 is completely covered by the telescopingtubes 32. With respect to the promotion of the smooth sliding of thetelescoping tubes 32 within each other, the bushings 56 can be made of aharder or softer stainless steel than the telescoping tubes 32, or canbe made from plastic. The smooth sliding of the telescoping tubes 32will be achieved by the smooth surface finish of the bushings 56 and thetelescoping tubes 32. If the bushings 56 are made of plastic, the smoothsliding will also be achieved by the low coefficient of friction betweenthe telescoping tubes 32 and the bushings 56. With respect to thepromotion of stiffness, the overlap between the ends of adjacenttelescoping tubes 32 functions to counter any side-load or momentapplied to the jaws 260, 262 of the gripping assembly 30.

If the cross-section of the telescoping tubes 32 is round, then a flator curved (e.g., concave) surface (e.g., see 57 in FIGS. 1, 5 and 27)can be machined or otherwise provided on the outer surface of eachtelescoping tube 32, and another corresponding flat or curved surface 59may be machined in the inner surface of the bore 52 of each telescopingtube 32 to guide the corresponding surface 57 of the adjacenttelescoping tube 32. This mating correspondence between the surfaces 57and 59 will prevent the telescoping tubes 32 from rotating with respectto each other when the shaft 22 is torqued during use of the clamp 20.The surfaces 57 and 59 function like keyways so that the surface 59 onthe inner surface of the bore 52 can ride along the surface 57 on theouter surface of the adjacent and smaller telescoping tube 32.

The Handle Assembly

The handle assembly 26 is best illustrated in FIGS. 1, 2, 4, 5, 6A, 6Band 15. The handle assembly 26 has a pivoting elongated handle piece216, and a stationary handle piece 116 that includes a cylindrical tube54 having a bore 110 extending therethrough. A ratchet assembly isprovided between the handle pieces 116, 216 for locking the jaws 260,262 of the gripping assembly 30 at varying degrees of clamping force.

The handle assembly 26 houses a cable terminator assembly that comprisesa cable holder 128 and an adjuster piece 130. FIG. 16 provides anisolated view of the cable holder 128, which has a generally cylindricalbody 132 having a bore 134 that extends from its distal end to alocation inside the body 132 between the distal and proximal ends of thebody 132. The proximal-most end of the cable 40 is secured (e.g., bybrazing or crimping) inside the bore 134. External threads 136 can beprovided on the outer surface of the cable holder 128 adjacent itsclosed proximal end. One or more flat regions 138 can be provided on theouter surface of the cable holder 128 to facilitate convenient gripping(e.g., by a wrench) when the cable holder 128 is being threadablyconnected to the adjuster piece 130.

FIG. 17 provides an isolated view of the adjuster piece 130, which has agenerally cylindrical body 148 having a threaded bore 150 extendingtherethrough. Two opposing walls 152 and 154 extend from the proximalend of the cylindrical body 148 to define an internal spacetherebetween. Each wall 152 and 154 has an opening 156 and 158,respectively, that are aligned with each other and through which a pin160 can be extended (see FIG. 6A). The internal space between the walls152, 154 is adapted to receive (in a pivoting connection) the transversepiece 124 of a ratchet rack 122, with the pin 160 inserted through theopenings 156, 158, and an aligned opening 157 in the transverse piece124 (see FIG. 15) to create a pivoting connection between the transversepiece 124 and the adjuster piece 130. The proximal end of the cableholder 128 is inserted into the bore 150 of the adjuster piece 130 viaan opening 168 in the distal face 170 of the adjuster piece 130. Theexternal threads 136 on the cable holder 128 threadably engage theinternal threads in the bore 150 to secure the cable holder 128 to theadjuster piece 130.

In addition to adjusting or calibrating the maximum tension in the cable40 and the maximum opening angle of the jaws 260, 262 of the grippingassembly 30 by adjusting the length of the shaft 22 (as describedabove), the maximum tension in the cable 40 and the maximum openingangle of the jaws 260, 262 of the gripping assembly 30 can also beadjusted or calibrated by changing the length of the cable 40 directly.The maximum tension of the cable 40 and the maximum opening angle of thejaws 260, 262 of the gripping assembly 30 can be adjusted or calibratedby turning the adjuster piece 130 when the pin 160 does not couple theadjuster piece 130 to the transverse piece 124. For example, when thepin 160 is removed from the openings 156, 158 and 157, the transversepiece 124 can be separated from the adjuster piece 130. This can only bedone by the manufacturer. By rotating the adjuster piece 130, thethreads 136 on the cable holder 128 translate in the threaded bore 150to either increase or decrease the length of the cable 40 (depending onthe direction of rotation). By decreasing the length of the cable 40,the jaws 260, 262 of the gripping assembly 30 close slightly, and themaximum force that the cable 40 can transmit to the jaws 260, 262 isincreased. By increasing the length of the cable 40, the jaws 260, 262open slightly, and the maximum force that the cable 40 can transmit tothe jaws 260, 262 is decreased.

Referring to FIG. 6A, the handle assembly 26 further houses a plasticbushing 178 that is cylindrical in configuration and has a hollow borethrough which the adjuster piece 130 can slide in a reciprocal manner.The plastic bushing 178 functions to allow the adjuster piece 130 toslide smoothly therethrough, and also prevents wear and tear between theadjuster piece 130 and the handle piece 116.

As shown in FIG. 6A, an end housing 196 is attached to the proximal end198 of the handle piece 116. FIG. 18 provides an isolated view of theend housing 196, which has a solid section 194 and a groove section 200.A longitudinal slit 208 is provided along the bottom of the groovesection 200 to allow the transverse piece 124 to reciprocatetherewithin. The solid section 194 of the end housing 196 has onethrough-hole 204 through which a threaded screw 206 can be inserted toconnect the end housing 196 to a corresponding threaded opening 207 atthe proximal end 198 of the handle piece 116.

FIG. 19 provides an isolated top perspective view of the handle piece116. Referring to FIGS. 6A and 19, the handle piece 116 has a cut-awaysection 112 at its distal end for receiving the upper boss 213 of ahandle end piece 114. A flush port 118 is provided on the handle piece116 to allow for cleaning of the components housed inside the handlepiece 116 and its bore 110. A slot 120 is provided on the underside ofthe handle piece 116 adjacent its proximal end to provide clearance forthe transverse piece 124 of the ratchet rack 122.

FIG. 20 provides an isolated bottom perspective view of the handle piece216. Referring to FIGS. 6A, 15 and 20, the handle piece 216 has alongitudinal channel 218 provided on its inner surface 220. Two opposingwalls 222 and 224 extend from the distal end of the handle piece 216 todefine an internal space therebetween. Each wall 222 and 224 has a firstopening 226 and 228, respectively, that are aligned with each other andthrough which a first pin 230 can be extended. The internal spacebetween the walls 222, 224 is adapted to receive the body of the handlepiece 116, with the first pin 230 inserted through the first openings226, 228, and an aligned opening 238 (see FIG. 19) in the handle piece116 to create a pivoting connection between the handle pieces 116 and216. The longitudinal channel 218 is adapted to receive the ratchet rack122 when the handle pieces 116 and 216 are gripped together (i.e.,closed).

Referring to FIGS. 6A and 15, the ratchet assembly includes a ratchet164 and a ratchet rack 122 that are removably engageable to allow thehandle pieces 116, 216 to be closed, or to be locked at a desired anglewith respect to each other. The ratchet rack 122 has a transmission link123 and a transverse piece 124 at the proximal end of the link 123. Thetransverse piece 124 has a plurality of teeth 125 provided on itsproximal-facing surface. A hooked end 126 extends from the distal end ofthe link 123, and has a hole 127. The hooked end 126 is retained in anarrowed channel 129 that extends from the distal end of thelongitudinal channel 218 in the handle piece 216. An opening 131 extendsthrough the side wall of the handle piece 216 from the exterior into thenarrowed channel 129, and a pin 133 extends through the opening 131 andthe hole 127 in the ratchet rack 122 to provide a pivoting connectionbetween the ratchet rack 122 and the handle piece 216. A set screw 135can be provided to secure the pin 133 in the openings 127 and 131.

The ratchet 164 essentially comprises a vertical piece that has twosmall and rounded handles 165 provided on either side at its bottom. Thehandles 165 can be used by the surgeon to disengage the ratchet 164 fromthe ratchet rack 122. The ratchet 164 has a first counterbore 166 in itsproximal face which is adapted to receive a spring 167. The ratchet 164also has a second counterbore 169 extending through its side wall forreceiving a hooked proximal end 171 of a transmission rod 173. Theratchet 164 also has an opening 174 extending through its side wall forreceiving a dowel pin 175 that also extends through an opening 176 inthe side wall of the handle piece 216. Set screws 177 and 179 can beprovided for securing the spring 167 and the dowel pin 175,respectively. In addition, a ratchet tooth 180 is provided at the upperend of the ratchet 164 in the distal-facing direction, and is adapted toengage one of the teeth 125 on the ratchet rack 122. The ratchet 164extends vertically through a hole 269 in the handle piece 216, and thespring 167 extends into another hole 271 in the handle piece 216 that istransverse to the hole 269. In other words, the paths of the holes 269and 271 are perpendicular to each other. The spring 167 naturally biasesthe upper end of the ratchet 164 towards the ratchet rack 122 about thepivot point defined by the dowel pin 175, so that the tooth 180 can bemade to engage a selected tooth 125.

The transmission rod 173 has a hooked proximal end 171 that is pivotablycoupled to the ratchet 164 at the opening 169. The distal end of the rod173 is coupled, such as by a threaded connection, to a threaded bore(not shown) in a gimble 182. By threading the rod 173 further in or outof the threaded bore in the gimble 182, the angle of the ratchet 164with respect to the handle piece 216 can be fine-tuned for optimalengagement between the teeth 180 and 125. The gimble 182 has a boss 183that extends from the bottom surface of the gimble 182.

Referring to FIGS. 15 and 24-26, the ratchet assembly further includes afirst ratchet release button 184 and a second ratchet release button 185that operate in conjunction with the gimble 182 and the transmission rod173 to release the engagement of the ratchet 164 with the ratchet rack122.

FIG. 21 provides an isolated perspective view of the second ratchetrelease button 185, which has a handle block 186 with a circular boss187. A hole 188 is provided in the circular boss 187 through which ashoulder screw 189 can be inserted and threadably coupled to a threadedhole 190 on the inner surface 220 of the handle piece 216. An extension191 extends at an angle from the boss 187, and carries a pin 192 at itsbottom surface. The second ratchet release button 185 can be pivotedwith respect to the handle piece 216 about a pivot point defined by theshoulder screw 189 and the hole 188.

FIG. 22 provides an isolated perspective view of the first ratchetrelease button 184, which has a handle block 193 with a curved shoulderpiece 205 extending at an angle from the handle block 193. A first hole195 is provided in the shoulder piece 205 adjacent the handle block 193,and is adapted to receive a shoulder screw 197 which can be insertedtherethrough and threadably coupled to a threaded hole 199 on the innersurface 220 of the handle piece 216. A circular boss 203 extends fromthe shoulder piece 205 at an angle from the handle block 193 and thefirst hole 195, and a second hole 201 is provided in the circular boss203 through which the boss 183 from the gimble 182 can be inserted. Anoffset shelf 202 extends from the shoulder piece 205, and has a slot 209that receives the pin 192 from the second ratchet release button 185.The first ratchet release button 184 can be pivoted with respect to thehandle piece 216 about a pivot point defined by the shoulder screw 197and the hole 195. In addition, the gimble 182 can be pivoted withrespect to the first ratchet release button 184 about a pivot pointdefined by the boss 183 and the hole 201. A screw 211 (see FIG. 26)secures the boss 183 of the gimble 182 to the hole 201.

FIG. 23 provides an isolated perspective view of a handle end piece 114,which has an upper boss 213 and a lower boss 214 that extend from acylindrical section 215. The cylindrical section 215 has a bore 217 inwhich the proximal-most telescoping tube 32 a can be retained. The upperboss 213 is attached to the cut-away section 112 of the handle piece 116by threading a screw 219 (see FIG. 6A) through an opening 221 in theupper boss 213 and a threaded hole 223 in the cut-away section 112 (seeFIG. 19). The lower boss 214 is seated over the bottom surface of thehandle piece 116. The handle end piece 114 also has a surface 225 thatprevents the tube 32 a from rotating. This surface 225 can be flat orcurved (e.g., concave), or can utilize known pin and slotconfigurations.

The operation of the ratchet assembly is best illustrated in connectionwith FIGS. 6A, 15 and 24-26. There are three possible configurations forthe ratchet assembly. In all configurations, it should be noted that thespring 167 always biases the tooth 180 of the ratchet 164 in the distaldirection towards the ratchet rack 124.

In a first configuration, the teeth 125 and 180 of the ratchet rack 122and the ratchet 164, respectively, do not engage each other. This isshown in FIG. 24. When in this opened position, the free ends of thehandle blocks 193 and 186 of the first and second ratchet releasebuttons 184 and 185, respectively, are generally pointed at each otherat an angle.

In a second configuration, the handle pieces 116, 216 are opened, thusthe teeth 125 and 180 of the ratchet rack 122 and the ratchet 164,respectively, do not engage each other, and the tooth 180 on the ratchet164 extends in a distal direction past the teeth 125 on the ratchet rack122. This is shown in FIG. 6A. When in this position, the free ends ofthe handle blocks 193 and 186 of the first and second ratchet releasebuttons 184 and 185, respectively, exactly parallel to each otherbecause the bias of the spring 167 causes the boss 203 of the firstratchet release button 184 to contact the boss 187 of the second ratchetrelease button 185.

In a third configuration, as the tooth 180 pivots in the distaldirection (about the pivot point defined by dowel pin 175), the rod 173and the gimble 182 are pushed in the distal direction to pivot the firstratchet release button 184 about the pivot point defined by the boss183. The tooth 180 engages a selected tooth 125 on the ratchet rack 122.This is shown in FIGS. 25 and 26. When in this position, the free endsof the handle blocks 193 and 186 of the first and second ratchet releasebuttons 184 and 185, respectively, are almost, but not exactly, parallelto each other. The surgeon can lock the jaws 260, 262 at varying degreesof clamping force by selecting a different tooth 125 to be engaged withthe tooth 180.

The engagement between the tooth 180 and a selected tooth 125 can bereleased in one or both of two ways. The surgeon can push the handles165 in the distal direction indicated by the arrow A in FIGS. 6A and 24,thereby pivoting the ratchet 164 about the pivot point 175 so that thetooth 180 is pivoted in a direction opposite to the arrow A, whichreleases the engagement between the tooth 180 and a selected tooth 125.Thus, the handles 165 operate as levers to pivot the ratchet 164.Alternatively, the surgeon can press one or both of the first and secondratchet release buttons 184 and 185 towards each other in the directionof arrow B in FIG. 26. The inward pivoting motion of one or both of theratchet release buttons 184, 185 will cause the circular boss 203 andthe boss 183 to pivot in the proximal direction, thereby pushing thegimble 182 and the transmission rod 173 in a proximal direction (seearrow C in FIG. 25) to pivot the ratchet 164 about the pivot point 175so that the tooth 180 is pivoted in a direction opposite to the arrow A,thereby releasing the engagement between the tooth 180 and a selectedtooth 125.

The handle assembly 26 is normally biased to the open position that isshown in FIGS. 1 and 6A. As described above, when a user grips the twohandle pieces 116 and 216 together, the pivoting at the pivot pointsdefined by the pins 133 and 160 will push the transverse piece 124 in aproximal direction (see arrow C in FIG. 25), which in turn pulls theadjuster piece 130 and the cable housing 128 in the same proximaldirection. As the cable housing 128 travels in the proximal direction,it will pull the cable 40 along with it, causing the cable 40 to bepulled in the proximal direction as well.

When the user's grip on the handle pieces 116, 216 is released, thespring 420 in the gripping assembly 30 (described in greater detailbelow) will bias the jaws 260 and 262 open, which will pull the cable 40in a distal direction (i.e., opposite to arrow C), and in so doing, willalso pull the handle pieces 116, 216 apart (i.e., open).

Locking Assembly for Locking Telescoping Tubes 32

FIGS. 9A-9C and 10 illustrate a locking assembly that is used to lockand secure the distal-most telescoping tube 32 b to the grippingassembly 30. The locking assembly also includes an alignment mechanismthat (1) guides and aligns the jaws of the gripping assembly 30 with theshaft 22 and the telescoping tubes 32, and (2) prevents the jaws 260,262 of the gripping assembly 30 from rotating when the telescoping tubes32 extend across the entire shaft 22 and are secured to the grippingassembly 30.

The locking assembly includes (1) a helix cylinder 58 that is secured tothe gripping assembly 30, and (2) a lock housing 70 that is movable withrespect to the helix cylinder 58 and which can be removably secured tothe helix cylinder 58.

Referring to FIGS. 11A-11C, the helix cylinder 58 has a generallycylindrical body 60 having a bore 62 extending therethrough. A dimple 63is provided on the outer surface of the body 60 for receiving the ball87 of the lock housing 70 (as described below). A first longitudinalslot 64 extends from the distal end of the body 60 for a short distancealong the body 60, and functions to align the helix cylinder 58rotationally when the helix cylinder 58 is welded to the grippingassembly 30 (as described below). A helical shoulder 65 is providedalong the outer surface of the body 60, extending helically fromadjacent the proximal end of the body 60 until it terminates at a secondshort longitudinal slot 66 at the bottom of the body 60. A spring 420 isretained inside the bore 62 and overlies the cable 40 (which extendsthrough the bore 62), as best shown in FIG. 9A.

Referring now to FIGS. 2, 9A-9C and 13A-13C, the lock housing 70 isattached to the distal-most telescoping tube 32 b. The lock housing 70has a generally rectangular body 77 having a generally cylindricalthroughbore that is divided into two sections, a distal section 78 and aproximal section 79 that has a larger diameter than the diameter of thedistal section 78. A step 80 defines the transition from the distalsection 78 to the proximal section 79. A portion of the distal-mosttelescoping tube 32 b is adapted to be retained inside the proximalsection 79, and the helix cylinder 58 is retained inside the distalsection 78. The step 80 prevents the distal-most telescoping tube 32 bfrom extending into the distal section 78. The top outer surface 81 ofthe lock housing 70 can be angled or slanted to provide a convenientpush surface for the user's finger, and ridges 82 can be providedanywhere along the outer surface (e.g., along the outer side walls) ofthe lock housing 70 for gripping purposes. A bottom hole 83 extends fromthe outer surface of the body 77 into the distal section 78 of thethroughbore, and a dowel pin 84 is received inside the hole 83. Atransverse bore 85 extends from the outer surface of the body 77 intothe distal section 78 of the throughbore. The transverse bore 85 has ashoulder 86 adjacent its opening into the distal section 78. As shown inFIGS. 9A-9C, a ball 87 is seated in the shoulder 86, and protrudesslightly into the distal section 78. The shoulder 86 prevents the ball87 from falling into the distal section 78. A spring 88 is placed in thetransverse bore 85 and is pressed against the ball 87 to maintain theball 87 against the shoulder 86. Another dowel pin 89 is positioned overthe spring 88 and the ball 87. Referring to FIGS. 14A and 14B, the dowelpin 89 has a interior bore 90 that retains the spring 88, with thespring 88 abutting at one end against the ball 87 and at the other endagainst the interior wall of the bore 90. The dowel pin 89 can besecured inside the bore 90 by screwing, pressing, brazing, gluing orwelding the dowel pin 89 into the bore 90.

The parts of the ball 87 that protrude into the distal section 78facilitate removable engagement with the dimple 63 of the helix cylinder58 in the following manner (see FIGS. 9A-9C): when the helix cylinder 58is inserted into the distal section 78, the body 60 of the helixcylinder 58 forces the ball 87 radially outwardly and compresses thespring 88. As the helix cylinder 58 is continued to be inserted into thedistal section 78, the ball 87 will eventually become aligned with thedimple 63, at which time the natural bias of the spring 88 will forcethe protruding part of the ball 87 into the dimple 63 to lock the lockhousing 70 at a defined position with respect to the helix cylinder 58.This combination of an outward radial force (from the body 60 of thehelix cylinder 58) and an inward radial force (from the spring 88) locksthe lock housing 70 to the helix cylinder 58.

A portion of a cable holder 72 (that is part of the gripping assembly30) is retained inside the bore 62 of the helix cylinder 58 and adaptedfor reciprocating movement in the bore 62. The cable holder 72 retainsthe distal-most end of the cable 40. Referring now to FIGS. 12A-12B, thecable holder 72 has a generally cylindrical body 73 having a bore 74extending from its proximal end and terminating at about the center ofthe body 73. A through-hole 75 is provided adjacent the distal end ofthe body 73 and is adapted to receive the pin 377 of the grippingassembly 30 (as described below). A vent hole 76 can be provided in thebody 73 for manufacturing purposes such as brazing, gluing or weldingthe cable 40.

As shown in FIGS. 9A-9C and 10, the cable 40 extends from the shaft 22through the helix cylinder 58 (and the spring 420) and into the bore 74of the cable holder 72. This distal-most end of the cable 40 is securedinside the bore 74 of the cable holder 72 by brazing, welding, crimpingor gluing.

The lock housing 70 and the helix cylinder 58 can function to guide andalign the jaws 260, 262 of the gripping assembly 30 with the shaft 22and the telescoping tubes 32, and to prevent the jaws 260, 262 of thegripping assembly 30 from rotating when the telescoping tubes 32 extendacross the entire shaft 22 and are secured to the gripping assembly 30.Referring first to FIGS. 2 and 9C, the lock housing 70 is shown as beingdisengaged from the helix cylinder 58, so that the lock housing 70 canbe retracted together with the telescoping tube 32 b that is attached toit. The lock housing 70 can be retracted proximally until it is adjacentthe handle end piece 114. When it is desired to completely cover theshaft 22 with the telescoping tubes 32, the user can grip the lockhousing 70 and then pull it towards the helix cylinder 58. As the lockhousing 70 approaches and engages the helix cylinder 58, two eventsoccur. First, the dowel pin 84 will contact the helical shoulder 65, andbe guided by the helical shoulder 65 until the dowel pin 84 is seatedinside the second slot 66, as shown in FIGS. 1 and 9A. Second, the helixcylinder 58 is inserted into the distal section 78 of the lock housing70 until the ball 87 becomes aligned with the dimple 63, at which timethe natural bias of the spring 88 will force the protruding part of theball 87 into the dimple 63. Once both of these events have occurred, thelock housing 70 is locked at a defined position with respect to thehelix cylinder 58 in a manner such that one cannot rotate with respectto the other. As a result, rotation of the jaws 260, 262 of the grippingassembly 30 can be prevented when the lock housing 70 is locked with thehelix cylinder 58.

The Gripping Assembly 30

One embodiment of the gripping assembly 30 is illustrated in connectionwith FIGS. 9A-9C and 10. The gripping assembly 30 is used to grip tissueor other anatomical structures (such as but not limited to a bloodvessel) during a surgical procedure. The gripping assembly 30 has a pairof gripping jaws 260 and 262 that can be pivoted to open and close withrespect to each other. Each jaw 260 and 262 has an insert (not shown)provided thereon. These inserts can be embodied in the form of any ofthe known inserts that are currently commercially available. Thetechniques and mechanisms for securing the inserts to the jaws 260 and262 are also well-known and will not be described herein.

The proximal end 266 of the first jaw 260 is secured inside a bore 350of a stationary jaw base 352. The jaw base 352 has a distal tubularsection 354 that defines the bore 350, a holder section that has a pairof opposing vertical walls 356 and 358, and a proximal wall section 360that is attached to the helix cylinder 58. The opposing vertical walls356 and 358 define a space 368 therebetween, and each vertical wall 356and 358 has an aligned opening 362 and 364, respectively. The proximalwall section 360 has a bore 366 through which a portion of the helixcylinder 58 (and the cable 40 carried therein) can extend. A hole 363extends from the top surface of the proximal wall section 360 into thebore 366, and a dowel pin 365 is inserted through the hole 363 and intothe slot 64 of the helix cylinder 58 to secure a portion of the helixcylinder 58 in a non-rotatable and fixed position inside the proximalwall section 360. According to one embodiment, the helix cylinder 58 canbe welded to the proximal wall section 360. Alternatively, the helixcylinder 58 can also be pressed, glazed, glued or screwed into the jawbase 352.

The proximal end 300 of the second jaw 262 is secured inside a bore 370of a pivoting jaw base 372. The jaw base 372 has an L-shapedconfiguration, with a longitudinal portion 374 that defines the bore370, and a transverse portion 376 that has a hole 378. The transverseportion 376 is comprised of two parallel walls that define a spacetherebetween, and with aligned second holes 380 provided in eachparallel wall.

The cable holder 72 carries the distal end of the cable 40 and extendsthrough the bore 366 of the jaw base 352 and into the space 368. The twoparallel walls of the transverse portion 376 of the jaw base 372 alsoextend into the space 368. The through-hole 75 of the cable holder 72 isreceived in the space between the two parallel walls of the transverseportion 376, and is aligned with the openings 380 on each of theseparallel walls. A pin 377 extends through the through-hole 75 and theopenings 380 to create a pivoting connection between the cable holder 72and the jaw base 372. In addition, the openings 362 and 364 in the jawbase 352 are aligned with the hole 378 of the jaw base 372, so a dowelpin 414 can extend through the openings 362, 364 and the hole 378 tocreate a pivoting connection between the two jaw bases 352 and 372.

As described above, the spring 420 is provided inside the helix cylinder58, and functions to continuously bias the jaw base 372 with respect tothe jaw base 352 by pushing or exerting a bias against the proximal end404 of the cable holder 72. In particular, the bias that is exertedagainst the proximal end 404 of the cable holder 72 pushes the cableholder 72 in the distal direction against the pin 377 to pivot the jawbase 372 about the pin 414 in a clockwise direction opposite to thearrow D as viewed in FIG. 9A, thereby pivoting the jaw base 372 awayfrom the jaw base 352 to open the jaws 260, 262. At the same time,movement by the cable holder 72 in the distal direction will pull thecable 40 in a distal direction, which will pull the cable holder 128,the adjuster piece 130, the pin 160, and the transverse piece 124 in thedistal direction. By pulling the transverse piece 124 in the distaldirection, the ratchet rack 122 pivots about the pin 133 to push thehandle pieces 116 and 216 apart from each other.

To close the jaws 260, 262, the surgeon grips the handle pieces 116, 216towards each other to overcome the bias of the spring 420. Inparticular, when the surgeon grips the handle pieces 116, 216, theratchet rack 122 is pivoted about the pin 133, and the transverse piece124 is pivoted about the pin 160, to pull the transverse piece 124 inthe proximal direction. This will pull the cable holder 128 and theadjuster piece 130 in the proximal direction, so that the cable 40carried in the cable holder 128 is also pulled in the proximaldirection. When the cable 40 is pulled in the proximal direction, thedistal end of the cable 40 that is secured to the cable holder 72 willalso pull the cable holder 72 in the proximal direction. As the cableholder 72 moves in the proximal direction, the cable holder 72 willovercome the bias of the spring 420 (see FIG. 9B), and will rotate thetransverse portion 376 of the jaw base 372 in the direction of arrow Dshown in FIG. 9A about the axis defined by the pin 414. This causes thepivoting jaw base 372 to pivot towards the stationary jaw base 352 toclose the jaws 260, 262 so as to grip a blood vessel, tissue or otheranatomical structure.

When the jaws 260, 262 have been closed, the surgeon can retract thetelescoping tubes 32 completely to nest and store all the telescopingtubes 32 inside the handle assembly 26, or the surgeon can retract some,but not all, of the telescoping tubes 32 so that only a portion (but notthe entire length of) the shaft 22 is exposed. The exposed portions ofthe shaft 22 will then be bendable by the surgeon in any directiondesired by the surgeon, so that the handle assembly 26 can be moved awayfrom the surgical site and not impede the surgeon's access to thesurgical site.

The jaws 260, 262 can be removed from the bores 350 and 370,respectively, and replaced with a different set of jaws, such as 260 a,262 a that are shown in FIG. 29. Reference should be made to U.S. Pat.No. 6,293,954 that is also assigned to the present assignee, whichdescribes how removable jaws such as 260 a, 262 a can be implemented.The entire disclosure of U.S. Pat. No. 6,293,954 is hereby incorporatedby this reference as though set forth fully herein.

Thus, the present invention provides a clamping device (the clampassembly 20) that can effectively clamp a blood vessel, tissue or otheranatomical structure at a surgical site, while not interfering with thesurgeon's access to the surgical site. The shaft assembly that includesa flexible shaft and nested telescoping tubes 32 allows the shaftassembly to be both completely rigid and completely flexible. The rigidshaft that is formed when the telescoping tubes 32 are fully deployed iscapable of withstanding axial loads, side loads, moments and torquesapplied to the jaws 260, 262. As a result, the surgeon can use the jaws260, 262 to poke and prod around the surgical site. In addition, thelock housing 70 ensures that the jaws 260, 262 are not rotatable withrespect to the shaft 22.

EXAMPLE

The clamp 20 of the present invention is especially well-suited for usein minimally-invasive procedures where the jaws 260, 262 can beintroduced through a port, trocar or small incision (hereinaftercollectively referred to as “Port”). Such minimally-invasive procedurescan include applications such as endoscopic or laproscopic applications.For example, during a minimally-invasive procedure, a surgeon may needto use an endoscope to view the surgical activity at the site of theprocedure. In such minimally-invasive procedures, the Port is of a smallsize such that the surgeon's hands cannot readily access the surgicalsite through the Port. As a result, the surgeon can only manipulate thejaws 260, 262 via the handle assembly 26.

When used in a minimally-invasive procedure, the surgeon grips thehandle pieces 116, 216 to close the jaws 260, 262, and then introducesthe closed jaws 260, 262 and a portion of the shaft 22 through the Portinto the interior of a patient. The surgeon then manipulates the jaws260, 262 (via gripping of the handle pieces 116, 216) to manipulate theblood vessels, tissues and other anatomical structures. During thismanipulation, the jaws 260, 262 can be either opened or closed. Ifclosed, the jaws 260, 262 can be used in a similar manner as a retractoror other blunt instrument. If opened, the jaws 260, 262 can be used as agripping element (i.e., like a clamp) or as a needle holder. Therigidity of the telescoping tubes 32 allows the surgeon to be able tomanipulate the jaws 260, 262 solely by controlling the handle pieces116, 216 that are positioned outside the patient's body. The rigid shaftthat is formed by the fully deployed telescoping tubes 32 protrudesthrough the Port which acts as a fulcrum. For example, if the surgeonwishes to move the jaws 260, 262 to the right, the surgeon merely movesthe handle pieces 116, 216 to the left to pivot the shaft 22 about thefulcrum. Next, the surgeon can (if desired) close the jaws 260, 262 bygripping the handle pieces 116, 216 to cause the jaws 260, 262 to grip avessel, tissue or anatomical structure.

With the shaft 22 extending through the Port, the surgeon can thenwithdraw the telescoping tubes 32 so that a portion of the shaft 22 isnow completely flexible and bendable. The tubes 32 can be withdrawn byfirst gripping and withdrawing the proximal-most tube 32 a which wouldlikely be outside the patient's body. Since the tubes 32 are locked toeach other in the manner shown in FIG. 28, withdrawal of theproximal-most tube 32 a will cause the tube 32 that is distal to (i.e.,adjacent to) the proximal-most tube 32 a to be withdrawn slightly aswell. At this time, each tube 32 will be pulled proximally, and thispulling force will cause the ball 87 in the lock housing 70 to bedisengaged from the dimple 63 of the helix cylinder 58. The surgeon canthen grip and withdraw the tube 32 that is distal to (i.e., adjacent to)the proximal-most tube 32 a. In this manner, the surgeon can grip andwithdraw each tube 32, one at a time, until all distal-most tube 32 bhas been withdrawn as well. The handle assembly 26 can then be movedaway from the surgical site.

Depending on the surgical procedure, some of the telescoping tubes 32can be extended again (or only some, but not all, of the tubes 32 can bewithdrawn) to cover a portion of the shaft 22 to render that portion ofthe shaft 22 completely rigid again.

In addition, if it is necessary to perform manipulation of othervessels, tissues or anatomical structures at the surgical site, thesurgeon can completely extend all the telescoping tubes 32 to render theshaft completely rigid again, and then manipulate the jaws 260, 262 (viathe handle pieces 116, 216) according to the steps described above. Toextend one or more tubes 32, the surgeon locks each tube 32 to anadjacent tube 32 using the dimples 139 and the tabs 141 according to thetechnique described above in connection with FIG. 28, and then pusheseach tube 32 (starting with the distal-most tube 32 b) back through thePort into the patient's body.

While the description above refers to particular embodiments of thepresent invention, it will be understood that many modifications may bemade without departing from the spirit thereof. The accompanying claimsare intended to cover such modifications as would fall within the truescope and spirit of the present invention.

1-49. (canceled)
 50. A shaft for use with a clamp device, comprising: acable which extends through a bore of the shaft; and a plurality ofalternating first beads and second beads defining the shaft, each of thefirst and second beads having an inner opening defining the bore of theshaft, and having a surface, wherein each of the second beads has alarger inner diameter of the inner opening than each of the first beads,each of the second beads is supported on the surface of two adjacentfirst beads at a line of contact, and the surface of each of the secondbeads has a convex shape at the line of contact.
 51. The shaft of claim50, wherein the surface of each of the first beads has a convex shape atthe line of contact.
 52. The shaft of claim 50, wherein each of thesecond beads has a larger outer diameter than each of the first beads.53. The shaft of claim 50, wherein each of the second beads has asmaller outer diameter than each of the first beads.
 54. The shaft ofclaim 50, wherein each of the second beads has the same outer diameteras each of the first beads.
 55. The shaft of claim 50, wherein the lineof contact is a circular line of contact.
 56. The shaft of claim 50,wherein the line of contact exists between the first beads and secondbeads at all times.
 57. A shaft for use with a clamp device, comprising:a cable which extends through a bore of the shaft; and a plurality ofalternating first beads and second beads defining the shaft, each of thefirst and second beads having an inner opening defining the bore of theshaft, and having a surface, wherein each of the second beads issupported on the surface of two adjacent first beads at a line ofcontact, and the surface of each of the first and second beads has aconvex shape at the line of contact.
 58. The shaft of claim 57, whereineach of the second beads has a larger outer diameter than each of thefirst beads.
 59. The shaft of claim 57, wherein each of the second beadshas a smaller outer diameter than each of the first beads.
 60. The shaftof claim 57, wherein each of the second beads has the same outerdiameter as each of the first beads.
 61. The shaft of claim 57, whereinthe line of contact is a circular line of contact.
 62. The shaft ofclaim 57, wherein the line of contact exists between the first beads andthe second beads at all times.
 63. A shaft for use with a clamp device,comprising: a central member; and a plurality of alternating first beadsand second beads alternatingly positioned along the central member todefine the shaft, wherein each of the first beads and the second beadshas an inner opening collectively defining a bore through the shaft, thecentral member extending through the bore, wherein the second beadscontact adjacent first beads along a line of contact, and wherein eachof the second beads has an inner opening having a larger inner diameterthan each of the first beads, each of the second beads is supported on asurface of two adjacent first beads at a line of contact, and thesurface of each of the second beads has a convex shape at the line ofcontact.
 64. The shaft of claim 50, wherein the first beads and thesecond beads have a three-dimensional convex torus configuration. 65.The shaft of claim 57, wherein the first beads and the second beads havea three-dimensional convex torus configuration.
 66. The shaft of claim63, wherein the first beads and the second beads have athree-dimensional convex torus configuration.